Pro-adrenomedullin levels predictive of death, HF
By
Levels of mid-regional pro-adrenomedullin were prognostic of early mortality and HF, and helped to improve risk stratification, study findings indicated.
The study included 745 patients with non-STEMI who had their plasma pro-adrenomedullin measured on admission and discharge. The primary endpoints over a mean follow-up of 760 days were a composite of death, HF, hospitalization and recurrent acute MI, whereas the events assessed individually were secondary endpoints.
During follow-up, there were 65 (8.7%) HF hospitalizations, 77 (10.3%) recurrent acute MIs and 120 (16.1%) deaths. Compared with established normal ranges, levels of admission (median: 0.81 nmol/L; range 0.06-5.75 nmol/L) and discharge (median: 0.76 nmol/L; range 0.25-6.95 nmol/L) were increased. Multivariate adjusted Cox regression models indicated that levels of admission and discharge were associated with the primary endpoint (HR=9.75 on admission, 7.54 on discharge; both P<.001). Admission pro-adrenomedullin in particular correlated with early mortality (P<.001) and, when compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and Global Registry of Acute Coronary Events (GRACE) score, was the only independent predictor of this endpoint.
According to researchers, this study represents the first report confirming activation of the adrenomedullin system in a cohort of patients with non-STEMI. “[Mid-regional pro-adrenomedullin] … represents a powerful new biomarker of risk of adverse events, death or HR rehospitalization beyond established clinical, biochemical or echocardiographic markers, NT-proBNP and GRACE score,” they wrote. “Admission [mid-regional pro-adrenomedullin] level is a particularly strong predictor of early mortality and, when >1.11 nmol/L, complemented the GRACE score to improve risk stratification.” – by Brian Ellis
Dhillon O. J Am Coll Cardiol. 2010;56:125-133.
-------------------------------------------------------------------------------------------------
Family history alone shown poor indicator for cholesterol screening in children
By
Children who qualify for pharmacologic treatment for dyslipidemia may go unnoticed if cholesterol screening is based solely on positive family history of cardiovascular disease, according to data from the Coronary Artery Risk Detection In Appalachian Communities project.
According to the researchers, had they relied on family history to select children for screening, one-third of the children who met the criteria for pharmacologic treatment would have been left out.
The study — designed to identify children and families at risk for coronary artery disease — included 20,266 fifth-grade children with a fasting lipid profile who had completed a family history questionnaire. The researchers determined the relationship between hyperlipidemia and family history using x2 analyses. They then used family history to predict the need for pharmacologic treatment in children with dyslipidemia.
According to the National Cholesterol Education Program (NCEP) guidelines, selective screening is suggested for those with a family history of premature cardiovascular disease, parent total cholesterol of >240 mg/dL and unknown family history. Of those included in the study, 71.4% qualified for cholesterol screening based on positive family history; 8.3% had dyslipidemia (low-density lipoprotein ≥130 mg/dL) and 1.2% were considered for pharmacologic treatment (low-density lipoprotein ≥160 mg/dL).
Nearly 10% of children who did not meet NCEP positive family history guidelines for screening had dyslipidemia; 1.7% qualified for treatment. Positive family history and hyperlipidemia (LDL ≥130 mg/dL) were related (P=.01), but the effect size was small (Cramer’s V=.02). Similarly, positive family history was associated with meeting treatment requirements (LDL ≥160 mg/dL; P=.004) but the effect size was small (Cramer’s V=.02). According to other analyses, using family history was not a good indicator of whether or not children need pharmacologic treatment (OR=0.692 [95% CI, 0.54-0.89], specificity = 0.63 [95% CI, 0.57-0.69] and sensitivity = 0.29 [95% CI, 0.28-0.29]).
“Universal cholesterol screening in the pediatric population will allow early diagnosis and appropriate treatment of children with significant dyslipidemia secondary to genetic and/or adverse lifestyle factors, hopefully preventing arterial disease,” the researchers wrote.
Ritchie SK. Pediatrics. 2010;126:260-266.
|